MO KEOVONGSA (NPI# 1710157300) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1710157300 |
| Entity Type | Individual |
| Full Name | MO KEOVONGSA |
| Credential | P.A. |
| Practice Address |
41 Mall Rd Lahey Clinic, Inc. Burlington MA 01805-0001 |
| Practice Telephone | 7817447000 |
| Practice Fax Number | 7817445352 |
| Mailing Telephone | 7817447000 |
| Mailing Fax Number | 7817445352 |
| Enumeration Date | 2008-03-10 |
| Last Update Date | 2014-10-21 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363AM0700X |
Physician Assistant Specialization: Medical |
AP2311 | MA | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
41 MALL RD LAHEY CLINIC, INC. |
| City | BURLINGTON |
| State | MA |
| Zip Code | 01805-0001 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770588923 | Gene Wong | Radiology | 41 Mall Rd, Burlington, MA 01805 | 2005-06-15 |
| 1689289977 | Justin Li | Student in an Organized Health Care Education/Training Program | 41 Mall Rd, Burlington, MA 01805-0001 | 2020-09-13 |
| 1235743741 | Rebecca C Mccarthy | Registered Nurse | 41 Mall Rd, Burlington, MA 01805-0001 | 2020-09-02 |
| 1730791419 | Jason Lefkowitz | Student in an Organized Health Care Education/Training Program | 41 Mall Rd, Burlington, MA 01805-0001 | 2020-08-23 |
| 1235749185 | Jing Lun James Xu | Student in an Organized Health Care Education/Training Program | 41 Mall Rd, Burlington, MA 01805-0001 | 2020-08-05 |
| 1841808482 | Evgeny Romanov | Student in an Organized Health Care Education/Training Program | 41 Mall Rd, Burlington, MA 01805-0001 | 2020-07-20 |
| 1780201319 | Nicole Emily Arsenault | Nurse Practitioner | 41 Mall Rd, Burlington, MA 01805-0001 | 2020-06-30 |
| 1841817590 | Joseph Clinton Mccabe | Student in an Organized Health Care Education/Training Program | 41 Mall Rd, Burlington, MA 01805-0001 | 2020-06-29 |
| 1730706508 | Hina Bhat | Student in an Organized Health Care Education/Training Program | 41 Mall Rd, Burlington, MA 01805-0001 | 2020-06-28 |
| 1902423734 | Jonathan Tong Xu | Student in an Organized Health Care Education/Training Program | 41 Mall Rd, Burlington, MA 01805-0001 | 2020-06-27 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1750867909 | Natalie Teresa Dal'bo | Student in an Organized Health Care Education/Training Program | 41 Mall Road Office of Graduate Medical Education, Burlington, MA 01805 | 2018-07-11 |
| 1043710791 | Beth Israel Lahey Health Primary Care, Inc. | Urology | Lahey Institute of Urology, Beverly, 41 Mall Rd., Burlington, MA 01805 | 2018-02-20 |
| 1902240872 | Lloyd Jones Jr. | Student in an Organized Health Care Education/Training Program | 41 Mall Rd Department of Plastic Surgery, Burlington, MA 01805 | 2013-04-23 |
| 1508020470 | Russell Andrew Baur | Internal Medicine | Lahey Clinic Inc., 41 Mall Road, Burlington, MA 01805 | 2008-07-10 |
| 1356491237 | Jacob Magee Sands | Internal Medicine | 41 Burlington Mall Rd., Lahey Clinic, Burlington, MA 01805 | 2007-01-11 |
| 1588757108 | Richard Alan Wold | Nurse Anesthetist, Certified Registered | Lahey Clinic Medical Center, 41 Mall Road, Burlington, MA 01805 | 2006-10-02 |
| 1841302387 | David M. Venesy | Internal Medicine | Lahey Clinic Cardiology -5 E, 41 Mall Road, Burlington, MA 01805 | 2006-08-31 |
| 1790750354 | Cara J. Foss | Nurse Practitioner | Lahey Hospital and Medical Center, 41 Mall Road, Burlington, MA 01805 | 2006-02-17 |
| 1750376380 | Darryl D Esakof | Internal Medicine | 41 Mall Road, Department of Cardiovascular Medicine, Lahey Clinic, Burlington, MA 01805 | 2005-09-20 |
| 1225022155 | Laura Saluja | Internal Medicine | Lahey Clinic - General Internal Medicine, 41 Mall Road, Burlington, MA 01805 | 2005-09-07 |
| Find all providers in zip 01805 | ||||
| Taxonomy Code | 363AM0700X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| Specialization | Medical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1306299532 | Courtney Simmons Scott | Physician Assistant | 5214 S Nc Highway 62, Burlington, NC 27215-9023 | 2016-07-23 |
| 1821408907 | Laramie Jay Richmond | Physician Assistant | 311 Davis St N, Burlington, ND 58722-2027 | 2014-04-29 |
| 1861668303 | Holly Griffin Hong | Physician Assistant | 1041 Kirkpatrick Rd Ste 100, Burlington, NC 27215-8066 | 2008-05-05 |
| 1407923329 | Martha Parnell Seagrave | Physician Assistant | 425 Pearl Street, Center for Health and Wellbeing, Burlington, VT 05401 | 2006-11-29 |
| 1053406462 | Susan W Fisher | Physician Assistant | 1240 Huffman Mill Road, Attn Emergency Department, Burlington, NC 27511 | 2006-10-03 |
| 1730186024 | Candace Campbell | Physician Assistant | 182 16th St, Burlington, CO 80807-1649 | 2005-07-01 |
| 1568005387 | Mackayla Renee Probasco | Physician Assistant | 911 Sunset Rd, Burlington, NJ 08016-2250 | 2019-10-24 |
| 1285275891 | Amber Blanchard | Physician Assistant | 104 Huffman Mill Rd, Burlington, NC 27215-5113 | 2019-10-04 |
| 1952811564 | Emilie Lise Besl | Physician Assistant | 111 Colchester Ave, Burlington, VT 05401-1473 | 2017-10-09 |
| 1699121244 | Cherie Hendrickson | Physician Assistant | 41 Mall Rd, Burlington, MA 01805-0001 | 2016-05-12 |
| Find all providers in BURLINGTON | ||||
| City | BURLINGTON |
| Zip Code | 01805 |
Please comment or provide details below to improve the information on MO KEOVONGSA.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.